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"Physiological" renal regenerating medicine in VLBW preterm infants: could a dream come true?
Daniela Fanni1, Clara Gerosa, Sonia Nemolato
1Department of Pathology, University of Cagliari, Cagliari, Italy. fandan73@yahoo.it
Insights
Low birth weight (LBW) and fetal growth restriction can impair kidney development, increasing adult hypertension and kidney disease risk. Enhancing nephrogenesis in preterm infants may prevent these conditions.
Area of Science:
- Nephrology
- Developmental Biology
- Pediatrics
Background:
- Adverse factors during fetal development, such as growth retardation and low birth weight (LBW), are hypothesized to impact renal development.
- This can lead to an increased risk of hypertension and kidney disease in adulthood.
- Nephrogenesis, the formation of new nephrons, continues postnatally in preterm infants for 4-6 weeks.
Purpose of the Study:
- To review factors influencing nephron number at birth, particularly in-utero experiences.
- To explore strategies for enhancing nephrogenesis in the perinatal period for preterm infants.
- To propose "physiological renal regenerating medicine" to improve kidney endowment and reduce long-term disease risk.
Main Methods:
- Review of recent literature on human nephrogenesis and factors affecting nephron number.
- Analysis of the impact of in-utero factors on fetal renal development.
- Discussion of postnatal nephrogenesis in preterm infants and potential therapeutic interventions.
Main Results:
- Specific adverse factors during fetal life are linked to impaired renal development and reduced nephron endowment.
- Postnatal nephrogenesis in preterm infants offers a window for intervention.
- Prolonging nephrogenesis until 36 weeks of post-conceptual age could mitigate future renal and hypertensive risks.
Conclusions:
- Interventions aimed at enhancing nephrogenesis in preterm infants, especially very low birth weight (VLBW) infants, are crucial.
- Extending the period of nephrogenesis could significantly improve long-term renal health and reduce susceptibility to hypertension.
- This approach, termed "physiological renal regenerating medicine," holds promise for preventing adult-onset kidney disease.
Abstract:
An emerging hypothesis from the recent literature explain how specific adverse factors related with growth retardation as well as of low birth weight (LBW) might influence renal development during fetal life and then the insurgence of hypertension and renal disease in adulthood. In this article, after introducing a brief overview of human nephrogenesis, the most important factors influencing nephron number at birth will be reviewed, focusing on the "in utero" experiences that lead to an increased risk of developing hypertension and/or kidney disease in adult. Since nephrogenesis in preterm human newborns does not stop at birth, but it continues for 4-6 weeks postnatally, a better knowledge of the mechanisms able to accelerate nephrogenesis in the perinatal period, could represent a powerful tool in the hands of neonatologists. We suggest to define this approach to a possible therapy of a deficient nephrogenesis at birth "physiological renal regenerating medicine". Our goal in preterm infants, especially VLBW, could be to prolong the nephrogenesis not only for 6 weeks after birth but until 36 weeks of post conceptual age, allowing newborn kidneys to restore their nephron endowment, escaping susceptibility to hypertension and to renal disease later in life.
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